Purpose: The purpose of this study was to establish the psychometric properties of a new instrument to assess functional ability among persons with dementia. Rationale and Background: Change in functional ability is a key feature of cognitive decline associated with Alzheimer’s Disease (AD). Function is a complex construct, inclusive of performing basic and instrumental activities of daily living (ADLs), being able to interpret the environment meaningfully, maintaining emotional stability, and interacting socially. In early work, we found existing measures of function had limited sensitivity across the full course of AD, with low variance and a ceiling effect by the middle stages of AD. The current instrument was developed to address this limitation, by providing more sensitive, detailed assessment, particularly for later stages of AD. Methods: Items were developed based on a comprehensive review of the literature on function, instruments used to measure this construct, and input of AD clinicians and researchers. Four major dimensions were generated: Basic ADLs, Instrumental ADLs/Cognition, Negative Affect, and Social Activity. Items were constructed using a 4-point scale, ranging from full function (=1) to complete dependence/no function (=4). Response stems were created to illustrate each item specifically. Geriatric experts reviewed the draft instrument for face validity. The sample was obtained from a larger longitudinal case-control study of AD caregiver-care receiver dyads, and included 147 persons with AD. Statistical methods included: descriptive analysis of instrument and sub-scales; factor analysis by sub-scale – exploratory (EFA, using 80 randomly selected subjects) and cross-validation (C-V, with remainder of sample); reliability analysis; construct validity comparing subscales to theoretically relevant measures; and ANOVA comparison by Mini-Mental State Exam (MMSE) score [low (<10), middle (11-18), high (>19)] to establish discriminant validity and test variability in very impaired persons. Results: Mean age was 75.2 (SD=8.4); 5.4% were African American, 94.6% Caucasian; 38.1% were female. MMSE scores were normally distributed, ranging from 0-30, mean 13.8 (SD 8.7). The table summarizes # of items, means, reliabilities (alphas), and % variance explained in exploratory and cross-validation factor analyses. Discriminant validity was shown with overall and subscale scores statistically different for three levels of MMSE (p<.05 for Neg Aff and p<.001 for overall, ADL, IADL and Soc Act). There was no ceiling effect, with similar variability across all cognitive levels. Subscale (#items) Mean (SD) Reliability EFA % var C-V % var ADL (11) 1.6 (1.8) 0.96 75% 78% IADL (11) 2.4 (.8) 0.93 68.5% 62.6% Neg Aff (12) 1.7 (.6) 0.85 60% 54% Soc Act (9) 2.0 (.7) 0.86 50.2% 62% Implications: This study demonstrated the usefulness of a new measure of functional ability, tapping multiple dimensions throughout the progress of AD. This instrument holds promise for use in studies evaluating interventions, or to establish changes in function across the full course of the illness. Future research will establish its utility in other illnesses with progressive cognitive loss. Funded by NIMH R01-MH47663 and #R)1-MH43267

Full metadata record

DC Field

Value

Language

dc.type

Presentation

en_GB

dc.title

Functional Assessment Tool for Dementia: Psychometric Properties

en_GB

dc.identifier.uri

http://hdl.handle.net/10755/158125

-

dc.description.abstract

<table><tr><td colspan="2" class="item-title">Functional Assessment Tool for Dementia: Psychometric Properties</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Young, Heather , PhD, GNP, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Oregon Heatlh and Science University, SON</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1250 Siskiyou Blvd, Ashland , OR, 97520, USA</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Anna Zisberg, RN, MS; Peter P. Vitaliano, PhD</td></tr><tr><td colspan="2" class="item-abstract"> Purpose: The purpose of this study was to establish the psychometric properties of a new instrument to assess functional ability among persons with dementia. Rationale and Background: Change in functional ability is a key feature of cognitive decline associated with Alzheimer&rsquo;s Disease (AD). Function is a complex construct, inclusive of performing basic and instrumental activities of daily living (ADLs), being able to interpret the environment meaningfully, maintaining emotional stability, and interacting socially. In early work, we found existing measures of function had limited sensitivity across the full course of AD, with low variance and a ceiling effect by the middle stages of AD. The current instrument was developed to address this limitation, by providing more sensitive, detailed assessment, particularly for later stages of AD. Methods: Items were developed based on a comprehensive review of the literature on function, instruments used to measure this construct, and input of AD clinicians and researchers. Four major dimensions were generated: Basic ADLs, Instrumental ADLs/Cognition, Negative Affect, and Social Activity. Items were constructed using a 4-point scale, ranging from full function (=1) to complete dependence/no function (=4). Response stems were created to illustrate each item specifically. Geriatric experts reviewed the draft instrument for face validity. The sample was obtained from a larger longitudinal case-control study of AD caregiver-care receiver dyads, and included 147 persons with AD. Statistical methods included: descriptive analysis of instrument and sub-scales; factor analysis by sub-scale &ndash; exploratory (EFA, using 80 randomly selected subjects) and cross-validation (C-V, with remainder of sample); reliability analysis; construct validity comparing subscales to theoretically relevant measures; and ANOVA comparison by Mini-Mental State Exam (MMSE) score [low (&lt;10), middle (11-18), high (&gt;19)] to establish discriminant validity and test variability in very impaired persons. Results: Mean age was 75.2 (SD=8.4); 5.4% were African American, 94.6% Caucasian; 38.1% were female. MMSE scores were normally distributed, ranging from 0-30, mean 13.8 (SD 8.7). The table summarizes # of items, means, reliabilities (alphas), and % variance explained in exploratory and cross-validation factor analyses. Discriminant validity was shown with overall and subscale scores statistically different for three levels of MMSE (p&lt;.05 for Neg Aff and p&lt;.001 for overall, ADL, IADL and Soc Act). There was no ceiling effect, with similar variability across all cognitive levels. Subscale (#items) Mean (SD) Reliability EFA % var C-V % var ADL (11) 1.6 (1.8) 0.96 75% 78% IADL (11) 2.4 (.8) 0.93 68.5% 62.6% Neg Aff (12) 1.7 (.6) 0.85 60% 54% Soc Act (9) 2.0 (.7) 0.86 50.2% 62% Implications: This study demonstrated the usefulness of a new measure of functional ability, tapping multiple dimensions throughout the progress of AD. This instrument holds promise for use in studies evaluating interventions, or to establish changes in function across the full course of the illness. Future research will establish its utility in other illnesses with progressive cognitive loss. Funded by NIMH R01-MH47663 and #R)1-MH43267</td></tr></table>

en_GB

dc.date.available

2011-10-26T20:32:03Z

-

dc.date.issued

2011-10-17

en_GB

dc.date.accessioned

2011-10-26T20:32:03Z

-

dc.description.sponsorship

Western Institute of Nursing

en_GB

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